Application of different priming dose of muscle relaxant in endotracheal intubation and general anesthesia / 中国医师杂志

ObjectiveTo study the effects of different priming dose of muscle relaxant at the onset and endotracheal intubation conditions.Methods120 ASA Ⅰ～Ⅱ grade patients were randomly divided into 6 groups (n=6),vecuronium group (V 1,V2,V3) and cis-atrscurium group (C1,C2,C3).All patients were induced with propofol plasma (TCI)3 μg/ml,fentanil3 μg/kg.The V1 and C1 group were not given priming dose,and the V2,V3,C2,C3 groups were given priming dose of 10 μg/kg,20 μg/kg vecuronium and 15 μg/kg,30 μg/kg cis-atracurium.Intubating conditions were evaluated,and the onset time was monitored with train-of-four (TOF) technique.ResultsIntubating conditions were excellent in all patients.The onset time of priming groups of the four different doses was significantly shorter than that of the nonpriming group [(80.5±7.2) vs (146±10.7);(79.8±6.5) vs (146±10.7);(138.5±7.2) vs (218±10.7) ; (127.1±6.5) vs (218±10.7),P ＜ 0.05 ].ConclusionsThe taking-effect time of priming dose of muscle relaxant was significantly shorter than that of the nonpriming dose group.Increasing the priming dose not decrease onset time more than the smaller dose.

The changes of parathyroid hormone and serum calcium in different modes of thyroid surgery / 中华内分泌外科杂志

ObjectiveTo investigate the changes of serum concentration of parathyroid hormone (PTH) and calcium after thyroid surgery and compare the changes among different modes of operation. MethodsFrom Aug. 2006 to Dec. 2009, 470 patients accepted thyroid surgery. The serum concentration of PTH and calcium in different groups was measured and compared before and 1 day after surgery. According to the extent and similarity of the surgery, patients were classified into 7 groups and they were compared in terms of postoperative changes of PTH and serum calcium. Statistical analysis was performed. ResultsThe serum concentration of PTH and calciurn decreased significantly after surgery in all patients except for those receiving unilateral and bilateral partial thyroidectomy. Compared with unilateral lobectomy, surgeries such as bilateral subtotal thyroidectomy, unilateral thyroidectomy with contralateral subtotal thyroidectomy, bilateral near-total thyroidectomy and total thyroidectomy resulted in more dramatic decreases of serum concentration of PTH and calcium and higher incidence of hypocalcemia ( P ＜ 0.05 ). The comparison between patients receiving CLND or not had the same result. Conclusions Almost all kinds of thyroid surgery affect the parathyroid function. The wider the surgery, the higher the possibility of postoperative hypoparathyroidism. The indications and criteria of different types of thyroid surgery are essential for hypoparathyroidism prevention. In some cases, vitamin D and calcium are recommended for preventive purpose.

Comparasion of two different detection methods for HER-2 protein expression and gene amplification in breast cancer tissue / 中华内分泌外科杂志

Objective To compare HER-2 state in breast cancer tissue deteced by fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC) and analyze their correlation. Methods HER-2/neu protein expression and gene amplification were detected by FISH and IHC in 56 newly-diagnosed cases of female breast cancer from July 2008 to July 2009. Results Of the 56 patients, HER-2 protein expression (-), (+), (++), (+++) was 9 cases (16.1%), 29 cases (51.8%), 11 cases (19.6%) and 7cases (12.5%) respectively; 26 cases (46.4%) had HER-2 gene amplification while 30 cases (53.6%) didnt have. Type of HER-2 gene amplification was mainly HER-2(++) and HER-2(+++), and according gene amplification rate was 72 7% and 100%. HER-2 (+) gene amplification rate was 37.9 %(11cases) and no gene amplification was found in HER-2(-) tissue. The HER-2 positive rate using two methods had significant difference(χ2=19.778,P<0.01). HER-2(-) and HER-2(+++) had good consistency with the FISH results(Kappa=0.969),but HER-2(+) and HER-2(+ +) were poorly consistent with the FISH results(Kappa=0.271). Conclusions IHC is the preliminary screening method for detection of HER-2 expression. HER-2(-) and HER-2(+++) have good consistency with the gene amplification, and can guide clinical treatment. Some patients with HER-2(+) and HER-2(++) have HER-2 gene amplification. FISH is needed for targeted therapy.

Total thyroidectomy plus functional neck lymph node dissection for the treatment of papillary thyroid carcinoma / 中华普通外科杂志

Objective To explore the pattern of cervical nodal metastasis and the clinical significance of total thyroidectomy plus functional neck lymphadenectomy in papillary thyroid carcinoma patients. Methods Clinical and pathological data of 172 patients with papillary thyroid cancer who underwent total thyroidectomy plus functional neck lymph node dissection at Jinan Military General Hospital were retrospectively reviewed, including patient demographics, extent of surgery, parathyroid hormone level,recurrence, tumor pathology, such as tumor size, multifocality, capsular invasion, vascular invasion,extrathyroidal extension, and lymph node status. Results Of the 172 functional neck dissection patients (47 ambilateral), the incidence of lymphonodus metastasis in regions Ⅵ, Ⅳ and Ⅲ was 96. 3% ,78. 5%and 62.1% respectively. Rate of nodal metastasis was higher in patients with extracapsular invasion than in patients with no invasion ( P ＜ 0. 05 ). Serum parathyroid hormone levels significantly decreased immediately postoperatively in total thyroidectomy plus functional neck dissection and remained low for several weeks thereafter ( P ＜ 0. 01 ). The 5-, 10- and 15-year survival rate was ( 98. 83 ± 0. 82) %, (98. 23 ± 1.02 ) % and (96. 42 ± 1.43 )%, respectively. Conclusions Therapeutic neck lymph node dissection for papillary thyroid cancer is recommended for cervical nodal metastasis patients. Total thyroidectomy plus functional neck dissection is important in the treatment of papillary thyroid cancer.

Expression of Fas/FasL in papillary adenocarcionoma of thyroid gland / 中国现代普通外科进展

Objective: To investigate the expressions of Fas, FasL in papillary adenocarcinoma of thyroid gland tissues and their tumor infiltrating lymphocytes(TIL), and its relationship with apoptosis and Fas, FasL in thyroid tumors.Methods: We detected the apoptotic rate and the expression of apoptotic related gene Fas in 43 cases of papliiary adenocarcinoma of thyroid gland with flow cytometry. The expression Fas and FasL were measured in 43 cases of papillary adenocarcinoma of thyroid gland, 28 cases of thyroid adenoma,43 paplillary adenocarcinoma of thyroid gland TIL,17 thyroid adenoma TIL using flow cytometry.Results: 19 cases in papillary adenocarcinoma showed low expression of Fas protein with an average apoptotic rate of 3.71% and 24 cases had high expression of Fas with an apoptotic rate of 7 26%(P

Clinical value of D-dimer testing in diagnosis of patients with deep vein thrombosis of the lower extremity / 中国普通外科杂志

Objective To discuss the clinical value of D-dimer(DD) testing in diagnosis of patients with deep vein thrombosis(DVT) of the lower extremity.Methods An analysis retrospectively was made on the changes of DD testing in 106 cases of DVT at different periods after onset and different clinical stages of DVT,and DD testing in 99 patients with primary deep venous insufficiency(PDVI) as control group.(Results) DD was higher in the acute stage of DVT,and gradually decreased with time in chronic DVT,and was negative in the patients with PDVI;the positive rate was up to 85.7% in the distal DVT.Conclusions The DD testing can be used as one of the methods for diagnosis,prediction and prognosis of acute DVT,especially for diagnosis of distal DVT.

Evaluation of cytological examination of impressed specimens in radical gastrectomy for gastric cancer / 中国普通外科杂志

Objective To determine the clinical value of cytological diagnosis of the impressed specimens in the radical gastrectomy for patients with gastric cancer. Methods During radical gastrectomies for 52 patients with gastric cancer, 232 impressed specimens were taken from the tumor tissues,paratumor tissues, proximal and distal incision margin,and partial lymph nodes respectively, to detect if there was tumor cells by cytological examination and compared with the pathology. Results In the tumor tissues,there were no pseudo positive specimen,and the pseudo negative specimen occurred in 1.In the incision margin,there was no pseudo negative specimen,while 12 pseudo positive specimens were found.In the paratumor tissues,there were 3 pseudo negative and 10 pseudo positive specimens.In all specimens,the sensibility was 92.8%; specificity was 85.8%; accuracy rate was 87.9%. Conclusions Cytological examination of the impressed specimens in radical gastrectomy is helpful in detecting residue tumor tissue in the incision margin, especially in hospitals without rapid pathologic examination.If cytological examination is combined with rapid pathological examination,the results will be better.

Effect of selective,non-selective nitric oxide synthase inhibitor and L- arginine on traumatic shock in rats / 中国普通外科杂志

Objective To investigate the effect of nitric oxide synthase(NOS) inhibitors and L-arginine(L-Arg) on the prognosis of traumatic shock in rats. Methods Traumatic shock models of Sprague-Daulay rats were made and randomly devided into control group (n=24),L-NAME treatment group (n=24),AG treatment group (n=24) and L-Arg treatment group (n=24). Serum nitric oxide(NO) levels and oxygen partial pressure in tissues include skeletal muscles,liver and small intestine were detected at 1h,3h,5h after resuscitation. Meanwhile, hemodynamic data of the rats and their survival rates of 12h and 24h were monitored and recorded. Results Serum NO concentration was statistically lower after resuscitation in L-NAME group than that in control group, while there were no statistical significance of tissues oxygen partial pressure and survival rate in 12、24h between the two groups. AG could decrease serum NO levels only at late stage of traumatic shock,but no effect on the synthesis and relase of NO at early stage of traumati shock.AG could improve tissues oxygen partial pressure of the liver and small intestine, and prolonged the mean survival time. L-Arg could increase serum NO levels, and improve oxygen partial pressure of intestine and significantly increase the survival rate at 12h and 24h in rats with traumatic shock. Conclusions Treatment with AG and L-Arg can improve the prognosis of traumatic shock rats much better than that with L-NAME.

Effects of intensive insulin therapy on the activity of nuclear factor kappa B in PBMC of the patients with critical illness complicated by hyperglycemia / 解放军医学杂志

Objective To observe the changes and significance of the activity of nuclear factor kappa B(NF-?B)in peripheral blood mononuclear cell(PBMC)of the critical patients with hyperglycemia,who were treated by intensive insulin therapy.Methods One hundred and twelve critical patients with hyperglycemia were randomly assigned to receive intensive insulin therapy(maintenance of blood glucose at a level between 4.4~6.1mmol/L,57 patients)or to receive conventional treatment(maintenance of blood glucose at a level between 8.0~11.1mmol/L,55 patients).2ml venous blood was collected to extract nucleoprotein in PBMC,and the NF-?B activity of PBMC was detected by electrophoretic mobility shift assay(EMSA)on 24h,4d and 10d.NF-?B oligonucleotide probe was labeled by digoxin.The Gel-Imaging system(UVP company)was used to record optical density values(OD)which represented the NF-?B activity.Results NF-?B activities in PBMC of the patients who received intensive insulin therapy(44.69?10.46,34.47?14.32 and 25.95?11.50 at the 24th hour,4th day and 10th day,respectively)were significantly lower than that of the patients who received conventional treatment(50.37?11.54,43.76?10.27 and 35.87?9.97 at 24th hour,4th day and 10th day,respectively,P